Anticoagulation in Pediatric Patients

Question 1

The anticoagulant most frequently used for DVT/PE in children

Answer 1

LMWH

Question 2

DOACs may be considered in what pediatric subgroup

Answer 2

Adolescent patients weighing >/= 50 kg

Question 3

Recommended labs prior to anticoagulation initiation

Answer 3

Baseline PT, PTT, CBC, and SCr

Pregnancy testing in menstruating females starting on warfarin

Question 4

LMWH anti-Xa target level for treatment

Answer 4

0.5 - 1.0 IU/mL (peak)

Question 5

LMWH anti-Xa target level for prophylaxis

Answer 5

0.1 - 0.3 IU/mL (peak)

Question 6

When to draw LMWH anti-Xa level (dose-wise)

Answer 6

After the 3rd or 4th dose

Question 7

When to start LMWH anti-Xa monitoring

Answer 7

Within two weeks after initiation

To assess for accumulation

Question 8

Is DVT prophylaxis routinely recommended for non-adolescent pediatric hospitalized patients?

Answer 8

No

Question 9

Warfarin starting dose inpatient (no liver dysfunction)

Answer 9

0.2 mg/kg (max 7.5 mg daily dose)

Question 10

Warfarin starting dose inpatient (liver dysfunction)

Answer 10

0.1 mg/kg (max 5 mg daily dose)

Question 11

If patient on warfarin going for procedure and INR is > 1.5 on the day of procedure

Answer 11

Vitamin K 1.25 mg stat day of procedure

Question 12

LMWH interruption guidance for periprocedural management

Answer 12

Hold LWMH 12 - 24 hours prior to procedure
Restart as soon as safe
Renal insufficiency may require longer holds

Question 13

Warfarin interruption guidance for periprocedural management

Answer 13

Hold warfarin 1 - 2 days depending on procedure risks

Renal insufficiency may require longer holds

Question 14

Warfarin to LMWH/UFH bridging guidance for periprocedural management

Answer 14

Only for high thromboembolic risk

Hold warfarin 3 - 5 days prior to procedure

If LMWH:
Start LMWH within 36 hours of the first held warfarin dose
Stop LMWH 12 hours prior to procedure if twice daily LMWH dosing

If UFH:
Stop UFH at least 4 hours prior to procedure

Check INR on day of procedure

Question 15

Enoxaparin treatment dose for premature neonate

Answer 15

2 mg/kg/dose SQ q12 hours

Question 16

Enoxaparin treatment dose for full term neonate

Answer 16

1.7 mg/kg/dose SQ q12 hours

Question 17

Enoxaparin treatment dose for 1 - 3 month infant

Answer 17

1.5 mg/kg/dose SQ q12 hours

Question 18

Enoxaparin prophylaxis dose for < 2 month infant

Answer 18

0.75 mg/kg/dose SQ q12 hours

Question 19

Enoxaparin prophylaxis dose for > 2 month infant

Answer 19

0.5 mg/kg/dose SQ q12 hours

Question 20

If thrombolytic is being used, how often to monitor labs

Answer 20

Every 6 - 12 hours during systemic thrombolysis

Question 21

When does the ASH 2018 guideline recommend Using antithrombin replacement therapy?

Answer 21

When standard anticoagulation has not worked and the patient has low AT levels

Question 22

Does the ASH 2018 guideline recommend using anticoagulation in neonates with renal vein thrombosis (RVT)?

Answer 22

Yes

Question 23

ASH 2018 recommendation for protein C deficiency (congenital purpura fulminas)

Answer 23

Protein C replacement with or without anticoagulation

Question 24

ASH 2018 recommendation for portal vein thrombosis with occlusive thrombus

Answer 24

Use anticoagulation

Anticoagulation is not suggested if nonocclusive thrombus or portal vein hypertension

Question 25

ASH 2018 recommendation for CSVT with hemorrhage

Answer 25

Use anticoagulation